Headache

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Classification 3 Etiology 4 Epidemiology 5 History 6 Clinical-manifestations 7 Complications 8 Management 9 More General Terms 10 Additional Terms 11 References

More Specific Terms

• analgesic rebound headache (transformed headache)
• chronic daily headache
• cluster headache (suicide headache)
• cold-stimulus headache (brain freeze)
• migraine headache
• orthostatic headache
• tension headache (stress headache)
• thunderclap headache

Classification

• (International Headache Society):
• migraine headache
• tension headache
• cluster headache & chronic paroxysmal hemicrania
• miscellaneous headaches not associated with structural lesion
• headache associated with head trauma
• headache associated with vascular disorders
• headache associated with non-vascular intracranial disorder
• headache associated with toxins, drugs or withdrawal
• headache associated with non cephalic infection
• headache associated with metabolic disorder
• headache or facial pain associated with disorder of face or cranium
• cranial neuralgias
• unclassified headache

Etiology

• acute angle closure glaucoma
• vasculitis - temporal arteritis
• infection

• meningitis
• acute sinusitis
• human immune-deficiency virus ( HIV)

• cryptococcal meningitis
• progressive multifocal leukoencephalopathy ( PML)
• encephalitis
• generalized sepsis

• stroke
• central nervous system ( CNS) mass lesion
• subarachnoid hemorrhage
• malignant hypertension
• pheochromocytoma
• toxic exposure

• carbon monoxide
• heavy metals: i) lead; ii) cadmium?
• mushrooms
• monosodium glutamate ( MSG)
• alcohol

• environmental factors

• video display terminal (eyestrain)
• cold exposure ( brain freeze)
• altitude ( acute mountain sickness)

• analgesic abuse
• lumbar puncture
• stress
• anorexia
• facial neuralgias, cutaneous allodynia [8]
• metabolic abnormalities

• hyponatremia
• uremia
• hyperglycemia/ hypoglycemia
• hypercarbia

• acute exertional headaches

• coughing; b) sneezing; c) straining; d) running; e) orgasm

• obstructive sleep apnea (morning headaches)
• pharmacologic causes:

• ergotamine ( withdrawal)
• nitroglycerin
• hydralazine
• indomethacin
• numerous others (see pharmaceutical agents associated with headache)

• also see chronic daily headache
• also see etiology of headache not apparent on noncontrast CT
• purely psychogenic headaches are rare

Epidemiology

• 93% of the population reports headache within the last 12 months
• 42,000,000 patient visits/year occur with headache as a chief complaint
• in children, occurs most frequently at age 13; 10% of children have recurring headaches [4]

History

• pulsating?
• without medications, duration 4-72 hours?
• unilateral?
• nausea?
• disturbance of daily activities?

• POUNDING (Pulsatile, One day, Unilateral, Nausea, Disturbing)

• 3/5 positive responses suggests migraine

Clinical-manifestations

• (WARNING signs in patients with headaches)
• headache during exertion or straining

• berry aneurysm
• increased intracranial pressure

• headache with fever

• meningitis
• encephalitis

• headache with nuchal rigidity

• meningitis
• encephalitis

• headache with drowsiness & confusion

• increased intracranial pressure
• meningitis
• encephalitis
• metabolic

• headache with abnormal physical exam ( pupil size, facial asymmetry, extraocular muscle abnormalities, abnormal fundoscopic exam, abnormal reflexes)

• subdural hematoma

• headache in a patient who looks ill

Complications

• chronic headache &/or migraine associated with risk of suicide ( hazzard ratio = 1.5-1.6) [9]

Management

• see specific type
• tricyclic antidepressants more useful than SSRI in patients with migraine or tension headaches [10]
• for chronic daily headache with characteristics of both tension headache & migraine, gabapentin (up to 2400 mg QD) may be useful [5]
• acupuncture may be of benefit for chronic headache [6]
• mirtazapine may be useful chronic tension headaches in patients without depression [7]
• opiates* may be useful for chronic headaches [7]

• * structured, monitored program

More General Terms

• pain [odyn-]

Additional Terms

• etiology of headache not apparent on noncontrast CT
• pharmaceutical agents associated with headache

References

1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1028-31
3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
4. Journal Watch 21(13):104, 2001 Fearon P & Hotopf H Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study. BMJ 322:1145, 2001 PMID: [1]
5. Journal Watch 24(3):23, 2004 Spira PJ et al Gabapentin in the prophylaxis of chronic daily headache: a randomized, placebo-controlled study. Neurology 61:1753, 2003 PMID: &dopt=Abstract
   - Silberstein SD, Neurology 61:1637, 2003
6. Journal Watch 24(11):91, 2004 Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 2004 Mar 27;328(7442):744. Epub 2004 Mar 15. <PubMed> PMID: [2] <Internet> [3]
7. Journal Watch 24(14):116, 2004 Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology. 2004 May 25;62(10):1706-11. PMID: [4]
   - Saper JR, Lake AE 3rd, Hamel RL, Lutz TE, Branca B, Sims DB, Kroll MM. Daily scheduled opioids for intractable head pain: long-term observations of a treatment program. Neurology. 2004 May 25;62(10):1687-94. PMID: [5]
8. Bigal ME, Ashina S, Burstein R, Reed ML, Buse D, Serrano D, Lipton RB; AMPP Group. Prevalence and characteristics of allodynia in headache sufferers: a population study. Neurology. 2008 Apr 22;70(17):1525-33. PMID: [6]
9. Veterans Administration Memorandum Dec 24, 2009 Recent VHA Findings regarding chronic pain conditions and suicide risk
10. Jackson JL et al. Tricyclic antidepressants and headaches: Systematic review and meta-analysis. BMJ 2010 Oct 20; 341:c5222 <PubMed> PMID: [7] <Internet> [8]
11. NIH Institute & Center Resources [9]
    - NINDS Headache Information Page [10]
12. National Guideline Clearinghouse
    - Headache. (American College of Radiology) ngc-guideline: [11]
    - Diagnosis and treatment of headache. Institute for Clinical Systems Improvement ngc-guideline: [12]
    - Diagnosis and management of headache Singapore Ministry of Health ngc-guideline: [13]
    - Inpatient treatment of headache: an evidence-based assessment. ngc-guideline: [14]
    - Neurophysiological tests and neuroimaging procedures in non-acute headache: guidelines and recommendations. European Federation of Neurological Societies ngc-guideline: [15]
    - Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache American College of Emergency Physicians ngc-guideline: [16]
    - Diagnosis and management of headache in adults. A national clinical guideline. Scottish Intercollegiate Guidelines Network ngc-guideline: [17] Guidelines from National Headache Foundation Standards of care for headache diagnosis and treatment.
    - Diagnosis and classification of primary headache disorders. In: ngc-guideline: [18]
    - Special treatment situations: alternative headache treatments. ngc-guideline: [19]
    - Special treatment situations: behavioral interventions for management of primary head pain. ngc-guideline: [20]
    - Special treatment situations: inpatient headache treatment. ngc-guideline: [21]
    - Treatment of primary headache: chronic daily headache. ngc-guideline: [22]
    - Treatment of primary headache: patient education. ngc-guideline: [23]
    - Headache - child. (American College of Radiology) ngc-guideline: [24]

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